Latinos experience a 50-100% higher burden of illness and mortality due to diabetes than White Americans. Diabetes, if inadequately controlled, produces major social and economic costs for affected families and the larger community. While there is recent evidence of success for diabetes lifestyle interventions, there is a need for new and creative approaches that maintain the intensity of these interventions and at the same time meet the needs of under-resourced racial/ethnic communities. Community health worker (CHW) interventions have shown great promise, particularly among poor communities of color, but there is a need to evaluate these interventions for their effectiveness and potential cost-savings. The overall aim of this community-based randomized controlled clinical trial (RCT) is to demonstrate the relative effectiveness of a CHW-led intervention designed to promote diabetes self-management and other healthy behaviors, compared to an enhanced usual- care (EUC) control group, among Latino residents of Detroit with physician-diagnosed type-2 diabetes. We will test the hypothesis that our CHW intervention led by trained Family Health Advocates (FHA) will increase knowledge of diabetes, increase physical activity, healthy dietary practices, improve diabetes self- management, and decrease HbA1c among Latino participants with diabetes. We propose to randomly assign 260 participants to either the FHA or EUC group. Participants assigned to the EUC group will receive invitations to community activities that are free and open to the public, including a general diabetes education class, physical activity classes, and healthy eating activities. The FHA group also will receive these invitations and the additional services of FHAs, who assist participants through a four-step, empowerment behavior change model and five-session diabetes education curriculum. FHAs also provide support services, including one-on-one education, accompanying clients on clinic visits, and linking clients to needed health care and other resources. Additionally, we hypothesize that the FHA group participants will have improved levels of patient activation compared to the EUC control group, as measured by health service utilization, completion of recommended tests, self-efficacy, and patient-provider communication. Finally, the cost-effectiveness of community health worker services that contribute to achievement of behavioral and clinical outcomes versus the EUC control group is hypothesized. This intervention will be implemented in collaboration with REACH Detroit, an existing partnership between university and community organizations which aims to reduce racial and ethnic disparities by preventing diabetes and its complications. The REACH Detroit and its collaborators have a successful record of community-based participatory intervention research.
This research aims to demonstrate how a culturally tailored community health worker intervention can be a cost-effective method for assisting Latinos with diabetes to improve their self-management skills and health status. If successful, the methods and results of this research will assist communities and health providers and systems to include community health worker services within their systems of care. Ultimately, we believe such interventions hold one key to eliminating disparities in diabetes care and diabetes complications.
